First paragraph (this article has no abstract)

In a recent issue of Critical Care, we read with interest the article by Lai and colleagues [1] in which they retrospectively analyzed the association between kidney function decline
after a non-dialysis-requiring acute kidney injury (AKI) and long-term mortality (median
follow-up of 700 days) in 634 intensive care unit (ICU) survivors. The authors found
that every 1 mL/minute per 1.73 m2 decrease from baseline-estimated glomerular filtration rate of individuals who progressed
to stage 3, 4, and 5 chronic kidney disease significantly increased the risks of mortality
by 0.7%, 2.3%, and 4.1%, respectively. This observation is novel and suggests that
a gradual decline in long-term renal function in non-dialysis-requiring AKI survivors
is associated with decreased survival. Curiously, the authors have not evaluated the
impact of sepsis on renal function and mortality. Sepsis is the most common cause
of AKI in the ICU, and patients with septic AKI are clinically distinct from those
with non-septic AKI [2-4]. First, septic AKI is associated with a greater burden of illness, concomitant non-renal
organ dysfunction, and need for mechanical ventilation and vasoactive therapy. Second,
patients with septic AKI are less likely to have impaired premorbid kidney disease.
Third, patients with septic AKI have longer hospital length of stay and increased
hospital mortality. Lastly, patients with septic AKI are more likely to recover kidney
function by hospital discharge. Therefore, the discrimination of septic and non-septic
AKI may have clinical relevance for clinicians, and sepsis should be taken into consideration
in analyzing not only short-term outcomes but also long-term renal function and long-term
mortality in critically ill survivors of AKI.